Wiki HBOT Diagnosis sequencing?

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sigmathree137

New
Local Chapter Officer
Messages
9
Location
Pomona, NY
Best answers
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Hi all,
We are having a debate as to the sequencing of diagnoses for HBOT for a patient.
The original order for the HBOT was for N30.41 (Irradiation cystitis with hematuria) from the urologist.
The indication on the note states "Soft tissue radionecrosis" but does not state where.
We know from the patient's chart that they ALSO have a diabetic foot ulcer, which is treatable with HBOT. It is not clear in the note if the soft tissue radionecrosis is referring to the bladder or the foot ulcer.

My question is, do we sequence the codes as:
N30.41
E11.621
L97.519
E11.22

OR:
E11.621
L97.519
N30.41
E11.22

Any insight would be appreciated.
 
0
Exactly! This is what the OP note says:

Hyperbaric Pre-Treatment
Chamber # : A
Treatment Number: 25
Total Treatments: 40
Consent Obtained: Yes
Patient Pregnant: Not applicable
Glasses, Jewelry, Makeup, etc. Removed: Yes
Dentures, Hearing Aid, Prosthetic Devices Removed: Yes
Prohibited Items : No
Cotton Gown: Yes
Cold/Flu Symptoms: No
Diabetic Patient Eaten: Yes
Medications Given: Yes
Medications taken prior to Tx : No
Otoscope Exam Performed: No
Ascultate Patient Lungs : No
Lines/Drains/Airways Assessed: Not applicable
Drainage Bags Emptied: Not applicable
Wounds Assessed: Not applicable
Wound Photos Taken: Not applicable
Ground Wire Secured: Yes
Air Mask Tested: Yes
Cardiac Monitoring: No
Safety Time Out : Yes
Hyperbaric Treatment
Indications: Soft tissue radionecrosis
Treatment Protocol : 2.0 ATA 90 minutes, two (2) five (5) minute air breaks
Risk Factors: Barotrauma, Hypoglycemia
Length of Treatment: (110)
Treatment Start Time: 1043
ATA Depth: 2
Pressure Reached : 1053
Decomp Begins : 1223
Treatment Status: Treatment ended
Treatment End Time: 1233

Physician comment:

Patient tolerated the treatment well. Continuous physician supervision was maintained throughout the treatment. No visual, auditory and cardio respiratory complication occurred during the treatment. Treatment today was uneventful. Pt tolerated well. No headache, No seizure, no ear pain, no sinus pain, no N&V, No pain. Less ear wax

Post treatment physical exam:
General: alert awake oriented x3, no acute cardiorespiratory distress
Lung sounds: Clear
Heart sounds: No JVD, No M
Less Wax, no fluid TM clear.
Tympanic membrane and middle ear:

Plan:
Patient will continue HBOT.
Pt has been followed by Neurology, no seizure activitity

Diagnosis
Irradiation cystitis with hematuria
 
0
I think that unless you query the provider for additional information about the site of the necrosis, all you can code is the N30.41. You cannot code the diabetic foot ulcer or the CKD unless your provider documents them as present at the current encounter.
 
0
What would you guys code if looking at the note at face value? I agree we should have queried the physician, but that is not possible now. I would think the cystitis is primary?
 
0
This is treatment #25 of 40 so that's one clue, and no wound was assessed or applicable leading toward the cystitis. And the Post DX is the real key to this: Irradiation cystitis with hematuria.
Why are you questioning the diagnosis when it's indicated on the note? Unfortunately you don't have any other diagnosis to report from this report but you probably don't need any more.
 
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